Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department

Barakat, Monique T.; Banerjee, Subhas

doi:10.4254/wjh.v12.i12.1289

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…Previous studies have identified potential predictors of malignancy as a cause for BDD that include symptoms of jaundice, increased age and coexisting intra‐ and extra‐hepatic dilation 7–11 . In our study, patients with jaundice or abnormal LFT were observed to have a significantly greater number of EUS findings compared to asymptomatic patients with normal LFT (78.8% vs 55.3%, P < 0.01).…”

Section: Discussionmentioning

confidence: 44%

“…ERCP has previously been considered the gold standard for the evaluation of pancreaticobiliary diseases including the detection of biliary stones and pancreatic neoplasms. However, in cases where the suspicion for pathology is low, less invasive and safer diagnostic modalities should be utilized, reserving ERCP for when other studies are non‐diagnostic (eg, primary sclerosing cholangitis [PSC]) or therapeutic intervention is required 8,15,16 . Post‐ERCP pancreatitis has been reported to occur in approximately 5%‐15% of patients, 1–4 while serious adverse events occur in just 1%‐2% of patients undergoing EUS‐FNA 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…A diagnosis of post‐cholecystectomy changes or underlying narcotic issues were made based on a lack of structural EUS findings to explain the confirmed dilation, but a clinical history suggestive of one of these diagnoses. The amount of narcotic use was not obtained quantitively but was identified as positive based on patient's reports, similar to reports from prior studies 8 . EUS‐FNA/FNB pathology was reviewed for correlation with the EUS findings.…”

Section: Methodsmentioning

confidence: 98%

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The role of endoscopic ultrasound in evaluating patients with bile duct dilation of unclear etiology

Phan

Kardashian

et al. 2021

J of Digest Diseases

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Objective Bile duct dilation (BDD) of unclear etiology is a common indication for further imaging via endoscopic ultrasound (EUS). We aimed to assess the yield of EUS in determining BDD etiology in patients with prior non‐diagnostic imaging studies. Methods A retrospective chart review was performed at a single, tertiary‐care university hospital for patients referred for EUS for BDD with or without pancreatic duct dilation (PDD). EUS‐guided fine needle aspiration (FNA) was performed if a focal lesion was identified. Cases with an etiology of BDD diagnosed or strongly suggested by prior imaging were excluded. EUS findings believed to represent a structural cause for BDD included a wide range of pancreaticobiliary and luminal pathology as well as patients' clinical factors. Results In total, 307 patients were identified. Findings to explain BDD were found by EUS in 213 patients for a diagnostic yield of 69.4%. Patients with jaundice were significantly more likely to receive a diagnosis by EUS than those without (78.8% vs 55.3%, P < 0.01). Notably, 8.1% of patients with normal liver function test (LFT) had a EUS‐diagnosed malignancy. Patients' age, narcotic use, concurrent PDD and prior cholecystectomy did not appear to influence the EUS yield. Conclusions EUS continues to play a substantial role in evaluating BDD of unclear etiology, most notably in patients with jaundice. In addition, given that 8.1% of asymptomatic patients without jaundice or abnormal LFT had malignancy diagnosed on EUS, the use of EUS for BDD of unclear etiology remains warranted.

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 98%

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The role of endoscopic ultrasound in evaluating patients with bile duct dilation of unclear etiology

Phan

Kardashian

et al. 2021

J of Digest Diseases

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“…According to a study, addiction to opium and a history of cholecystectomy are associated with CBD dilatation in the absence of an obstructive process. 22 Another study reported a minor increase in bilirubin levels in four opium-addicted patients who had Oddi’s sphincter dysfunction and CBD dilatation. It was shown that the papillary obstruction is more common than other Oddi’s sphincter malfunctions in addicted patients.…”

Section: Discussionmentioning

confidence: 99%

Addiction and the Risk of Common Bile Duct Stones: A 4-Year Retrospective Population-Based Study in Mashhad, Iran

Beheshti Namdar,

AkbariRad,

Farzaneh Far

et al. 2023

Addict Health

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Background: As a common digestive disorder, choledocholithiasis can have serious consequences, including death. Given that opioids have been shown to contribute to the spasm of Oddi’s sphincter, which results in biliary stasis in the common bile duct (CBD), it is likely that opioids can also raise the prevalence of choledocholithiasis. In this regard, this study aimed to investigate how common opium addiction was among choledocholithiasis patients in Mashhad, Iran. Methods: The current retrospective observational study was conducted on 599 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP), utilizing information gathered at the Ghaem hospital in Mashhad, Iran, between 2011 and 2015. Patient data were collected from files and records using certain criteria such as gender, opium addiction, hepatic enzymes (AST, ALT, ALP), plasma levels of total bilirubin, and direct bilirubin. The size of the CBD stones as well as the correlation between the gallbladder and CBD stones were calculated. Findings: From among 599 patients included, 345 (57.6%) were female and 254 (42.4%) were male. Moreover, 195 patients (32.2%) had opiate addictions. The size of the CBD stone was correlated with the patient’s age (r=0.17, P=0.001). The average stone measured 12.22±3.32 mm. There were notable differences in the mean size of the CBD stone (P<0.001) between addicted and non-addicted cases; specifically, the mean CBD stone size in addicted cases was 12.715.13 mm while it was 12.34.33 mm in non-addicted cases. Conclusion: This study showed patients with CBD stones have a higher rate of opium addiction compared to the general population, indicating a possible link between the two conditions.

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“…Duct dilation is an imperfect clinical biomarker given the prevalence of physiologic dilation that occurs with cholecystectomy, aging, and opioid use. 9 Similarly, the specificity of elevated liver chemistries as an SOD indicator is compromised by the high baseline rate of metabolic dysfunction associated steatotic liver disease (MASLD, estimated prevalence 10-35%) 10 as well as abnormal aminotransferase levels in the general population (estimated prevalence 10-30%). [11][12][13] Finally, iRAP is a subjective diagnosis since physicians commonly diagnose acute pancreatitis in the absence of radiographic changes and deeming a case idiopathic varies across clinical practices and individual cases.…”

Section: Introductionmentioning

confidence: 99%

Sphincterotomy for Biliary Sphincter of Oddi Disorder and idiopathic Acute Recurrent Pancreatitis: THE RESPOND LONGITUDINAL COHORT

Coté,

Elmunzer,

Nitchie

et al. 2024

Preprint

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Objective: Sphincter of Oddi Disorders (SOD) are contentious conditions in patients whose abdominal pain, idiopathic acute pancreatitis (iAP) might arise from pressurization at the sphincter of Oddi. The present study aimed to measure the benefit of sphincterotomy for suspected SOD. Design: Prospective cohort conducted at 14 U.S. centers with 12 months follow-up. Patients undergoing first-time ERCP with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids, and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme. Results: Of 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP, or some combination. By imputation, an average of 122/213 (57.4% [95%CI 50.4-64.4]) improved; response rate was similar for those with complete follow-up (99/161, 61.5%, [54.0-69.0]); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs, and patient characteristics were not associated with response. AP occurred in 37/213 (17.4%) at a median of 6 months post-ERCP and was more likely in those with a history of AP (30.9 vs. 2.9%, p<0.0001). Conclusion: Nearly 60% of patients undergoing ERCP for suspected SOD improve, although the contribution of a placebo response is unknown. Contrary to prevailing belief, duct size and labs are poor response predictors. AP recurrence was common and like observations from prior non-intervention cohorts, suggesting no benefit of sphincterotomy in mitigating future AP episodes.

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Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department

Cited by 10 publications

References 35 publications

The role of endoscopic ultrasound in evaluating patients with bile duct dilation of unclear etiology

The role of endoscopic ultrasound in evaluating patients with bile duct dilation of unclear etiology

Addiction and the Risk of Common Bile Duct Stones: A 4-Year Retrospective Population-Based Study in Mashhad, Iran

Sphincterotomy for Biliary Sphincter of Oddi Disorder and idiopathic Acute Recurrent Pancreatitis: THE RESPOND LONGITUDINAL COHORT

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